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Hospice Care/Facial features at the time of death


Christine, my father passed away 2 days ago at home.  I was by his bed side holding him all morning until he took his last breathe.  My question to you is; just before he started with his last 3 labored breathes which took a total of 5 minutes, he clenched his entire body and face (mouth area) , eyes squeezed tightly shut, his skin turned red/purple with a swollen appearance for about 30/45 seconds and then exhaled. What was happening? Was he having a stroke? Heart attack? Was it fear? I do believe that spiritual warfare goes on for the souls of the dying.  But, I prayed over my dad and we prayed together that morning and days past.  My heart is struggling with this.

Dear Celeste--How sorry I am for the loss of your Dad, but how happy I am that you were with him and had been so close to him for so long.  What a lovely relationship it seems you two had!

It is not unusual for the last few breaths to be labored and to kind of drag out.  Sometimes they are a little rattly sounding too.

Recall that there are many times when we clench our bodies--excitement, anticipation and great effort might all result in our clenching our muscles.  Since it was clear that your Dad had good pain management, I must assume that he wasn't not tightening up his muscles from pain or fear, but from, perhaps, the anticipation of what was to come.

The purplish color is common when circulation is slowed or impeded.  It can happen because a heart and/or lungs are not operating fully and well, or it can also be because those muscles were clenched up.  All we have to do is look in a mirror while we hold our breath and tighten a bunch of muscles, and our faces get that way too.  So I think that's what that was.

It is possible he was having a stroke or a heart attack--slowed up circulation can cause either or both.  But it is unlikely that he had either of those, unless his terminal condition would have made them more likely.

From what I understand from stories told by persons who essentially died and then were somehow revived, there is some unpleasantness which is supposed to encourage the dying person (if he or she has not been very nice) to realize their misbehaviors and make a conscious decision to take responsibility.  Invariably, those people have returned to life on earth, much more decent and giving and honest.  Whether that is everyone's experience I cannot say.  I would suggest this to you, though....  Your Dad was a God-fearing man who knew how to pray.  I suspect that he was a decent, giving, caring man.  This is someone who goes to a "reward" rather than "punishment."  I don't believe we are "up for grabs" at the end.  I believe we have a loving God who, like a firm and loving parent, is encouraging, supporting and caring.

I cannot believe there was any debate or "warfare" over your Dad's soul, although it is certainly not up to me, and I don't have any inside information.  I don't think anyone does, regardless of what they may say.

I believe you will come to a place, perhaps sooner, perhaps later, where a peace comes over you and you will know in your heart that your Dad is OK.  Some people have experiences where they hear their dead parent's voice (it happened to me, and then later to my brother and sister, all of us at different times--you can bet we were surprised when we all shared those experiences!).  But not everyone does.

Here's what I do know.  Your Dad can and probably did take responsibility for himself.  His reward is his and his alone.  I think you can take comfort that a loving God took him in, if that is how you believe.

My suggestion is that now that your Dad is not here to pray with you, talk to him as though he were here.  You don't know that he cannot hear you!  And you will find comfort in sharing with him.  You should also cry when you feel the need--and laugh when you remember things that were funny at the time.

Your father raised a loving daughter.  I wish you peace and I hope this has helped at least some.


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Christine Johnson


I can give suggestions, encouragement and direction on what hospice is and is not, when it is appropriate, and how to go about getting it. I am familiar with Medicaid and Medicare hospice benefits. I can answer general questions about disease process, what dying looks like, how hospice handles pain and other symptoms, what to expect from a hospice when end of life nears. I can provide support, direction and encouragement related to spiritual matters and psychological matters related to death and dying.


I am a certified hospice and palliative care nurse, and have been the director of nurses for three hospice centers, under two different companies. I have also worked as a contract hospice nurse for a large American hospice company. On a personal level, my father died without benefit of hospice (it was not popular then). I have taken care of dying patients in hospitals and recognize that for most of us, it is preferable to die at home (or in our residence, wherever that may be), comfortably and without anxiety. Also I had no support when my father died; hospice clients are the whole family (however that is defined by the "patient"), and support is provided at least a year after the patient passes. These are the sorts of things (and probably others) that I can help with.

HPNA (Hospice and Palliative Nurses Association)

none yet

Registered Nurse (TX), Licensed Marriage and Family Therapist (TX) ADN Nursing, Excelsior College, Albany, New York (2004) 4.0 GPA BA, Psychology (minor Social Work), Oklahoma University, Norman, OK (1986) 3.67 GPA MHR (MA) Human Relations, Oklahoma University, Norman, OK (1988) 3.5 GPA

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